I don't like buying The Times because I don't really approve of Rupert Murdoch, but fortunately you can access it on-line; today's issue carries this superb analysis of current NHS politics.
Is this a resignation issue? It is getting perilously close.
When ministers are forced to backtrack not once but twice or three times, finally conceding the very points made from the start by their critics, their position is fatally weakened. Had Lord Warner, the minister who could most plausibly be blamed for the junior doctor appointment system, not chosen to retire at the end of last year, he would be on his way any day now. His absence leaves Patricia Hewitt, the Health Secretary, rather exposed.
She may not be directly culpable for the failings of the application system, but she is culpable for the political error of not seeing early enough that this was an issue that could not be finessed. At every stage she has been a yard off the pace. Today’s court action by RemedyUK is the key. If the court rules that doctors’ reasonable expectations of fairness were not met, then she will face another retreat. If, on the other hand, it finds for her, she will be home clear – winged but still defiantly flapping.
Scotland, Northern Ireland and Wales can offer doctors four interviews, but apparently England cannot. After ten years’ training, their futures are to hang on a banal application form, dodgy computer software and a single interview. Small wonder they are angry.
And what will happen if, through the misguided workings of the application system, thousands of overseas doctors are appointed to posts while thousands of expensively trained British doctors are not? The political consequences would be huge.
Law firms would never tolerate their trainees being selected in such a way: nor would newspapers, or any properly run business. Will hospitals really put up with the wrong doctors being imposed on them for the next five years?
It is symptomatic of the arrogance of NHS management that such a “Year Zero” approach was ever adopted. In the attempt to undermine the old boy network that, it claims, characterised the old interview system, the department came up with something infinitely more sinister. And where were the defenders of medical professionalism? The royal colleges were silent, the Postgraduate Medical Education Training Board denied responsibility, and the British Medical Association equivocated. Not my problem, guv.
It is no surprise that so many doctors despair of their profession when there are so few prepared to defend it.
Wednesday, 16 May 2007
It's not our fault
This is a report of Prime minister's Questions today; John Prescott was standing in for Mr Blair.
Mr Hague said Mr Prescott would be "missed" by the Tories and "wished him well in his retirement" after 37 yeas in the Commons. He asked if the government would apologise for mistakes made over the computer system for junior doctors' jobs.
Mr Prescott said he was not leaving the Commons and said it was nice to hear he would be missed. He said he would not be "whingeing on the backbenches" when he retired from the frontbench "as I hear some of my colleagues doing from time to time".
Mr Prescott hailed Labour's record on employment and help for pensioners, compared with the previous Tory government, adding "can I say I am the longest serving deputy prime minister" and had seen off five Tory counterparts.
Mr Hague said his question had been about junior doctors. He asked who was responsible in government for the "fiasco" of the online recruitment system.
After a pause, Mr Prescott said: "Tories".
So that's reassuring - it's nothing to do with Mrs Hewitt.
Mr Hague said Mr Prescott would be "missed" by the Tories and "wished him well in his retirement" after 37 yeas in the Commons. He asked if the government would apologise for mistakes made over the computer system for junior doctors' jobs.
Mr Prescott said he was not leaving the Commons and said it was nice to hear he would be missed. He said he would not be "whingeing on the backbenches" when he retired from the frontbench "as I hear some of my colleagues doing from time to time".
Mr Prescott hailed Labour's record on employment and help for pensioners, compared with the previous Tory government, adding "can I say I am the longest serving deputy prime minister" and had seen off five Tory counterparts.
Mr Hague said his question had been about junior doctors. He asked who was responsible in government for the "fiasco" of the online recruitment system.
After a pause, Mr Prescott said: "Tories".
So that's reassuring - it's nothing to do with Mrs Hewitt.
Monday, 14 May 2007
From The Times (14th May)
Doctors' job system 'has failed at all stages - and its review is a fiasco too'
Nigel Hawkes, Health Editor
An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today.
The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court.
The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days.
Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.
In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”.
The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures.
There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.
Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall.
To get a doctor to this stage costs the state £250,000 in education and training costs. The potential losses would easily exceed £1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad.
One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.
This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS.
The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.
Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.
So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .”
RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.
Nigel Hawkes, Health Editor
An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today.
The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court.
The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days.
Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.
In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”.
The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures.
There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.
Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall.
To get a doctor to this stage costs the state £250,000 in education and training costs. The potential losses would easily exceed £1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad.
One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.
This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS.
The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.
Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.
So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .”
RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.
Saturday, 12 May 2007
Advice available
So Gordon Brown has said that the NHS is to be his number one domestic priority; good.
He has said that he wants to listen to health professionals ; good.
He then says that he wants to extend NHS Direct, which any health professional will tell him is useless, wants to expand drop-in centres, which are both useless and dangerous (since they eliminate continuity of care) and wants GPs available in the evening and at weekends ( which may be good, but has only just been ended by the government with the new GP contract).
If Gordon really wants to listen, I am available to talk. I look forward to it, and I promise not to charge as much as the management gurus who have been wreaking so much havoc on the NHS.
I am standing by for the phone call.
He has said that he wants to listen to health professionals ; good.
He then says that he wants to extend NHS Direct, which any health professional will tell him is useless, wants to expand drop-in centres, which are both useless and dangerous (since they eliminate continuity of care) and wants GPs available in the evening and at weekends ( which may be good, but has only just been ended by the government with the new GP contract).
If Gordon really wants to listen, I am available to talk. I look forward to it, and I promise not to charge as much as the management gurus who have been wreaking so much havoc on the NHS.
I am standing by for the phone call.
Friday, 11 May 2007
Where's Wally? (part two)
On a recent post (subsequently featured by a local newspaper) I mentioned the disappearance of the Chief Executive of the East of England Strategic Health Authority, Neil McKay.
Now, even more alarmingly, the whole of the SHA (the organization which funds and overseas the whole of the NHS in the East of England) seems to be in hiding.
The SHA has public board meetings (which I imagine very few of the public actually attend) and publishes on its website the agenda and papers for these meetings; these papers are a gold mine of information, particularly in relation to how badly the SHA is missing its targets on Choose and Book, and how it is doing conjuring tricks with the money. It is, after all, public information, and our money.
But now they have gone all bashful. The next public meeting of the board is on 17th May, but there is still (despite two reminders from me) no agenda, no papers, and no minutes of the last meeting in March.
What have they got to hide?
Now, even more alarmingly, the whole of the SHA (the organization which funds and overseas the whole of the NHS in the East of England) seems to be in hiding.
The SHA has public board meetings (which I imagine very few of the public actually attend) and publishes on its website the agenda and papers for these meetings; these papers are a gold mine of information, particularly in relation to how badly the SHA is missing its targets on Choose and Book, and how it is doing conjuring tricks with the money. It is, after all, public information, and our money.
But now they have gone all bashful. The next public meeting of the board is on 17th May, but there is still (despite two reminders from me) no agenda, no papers, and no minutes of the last meeting in March.
What have they got to hide?
Thursday, 10 May 2007
Campaign update
This week the Save Bedford Hospital campaign has been featured in the Bedfordshire Times and Citizen, Bedfordshire on Sunday, and Chiltern FM radio.
Dr Rob Oakley, one of my campaign team, is currently on a charity cycle ride (in aid of the Bedford Sports Foundation and the Bedford Hospital Charity) from Land's End to John O'Groats, so our message is being spread far and wide.
Dr Rob Oakley, one of my campaign team, is currently on a charity cycle ride (in aid of the Bedford Sports Foundation and the Bedford Hospital Charity) from Land's End to John O'Groats, so our message is being spread far and wide.
Wednesday, 9 May 2007
The new NHS
Jack and Jill went up the hill to fetch a pail of water
Jack fell down and broke his crown and Jill came tumbling after
Both subsequently died in the ambulance and the PCT set up an enquiry, which came
to the following conclusions:
The 50 mile journey to the nearest casualty department was in the couples' best Interests. The fact that there was no local bed in which Jack could mend his head was
unfortunate but no targets had been breached and he had been offered a Choice.
The lack of vinegar and brown paper was not material to the man’s death as NICE had not yet decided whether it was cost-effective and in any case both the brown
paper nurse and the vinegar nurse were away on courses
The GP was most to blame and should be suspended and referred to the GMC as he had:
1 Not reported Jack and Jill's lack of water to social services
2 Failed to recognise that anyone going UP the hill to fetch a pail of water must be
seriously demented
(Thanks to the person who sent me this)
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